Provider Demographics
NPI:1235166414
Name:MAHONEY, THOMAS LANG (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LANG
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2841
Mailing Address - Country:US
Mailing Address - Phone:585-586-5656
Mailing Address - Fax:
Practice Address - Street 1:3875 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9147
Practice Address - Country:US
Practice Address - Phone:585-334-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0977OtherBCBS NUMBER
NY142554OtherLISCENSE
NY010142554OtherBLUE CHOICE
NY187AOtherPREFERRED CARE ID
NY00762203Medicaid
NYCIM 231398OtherWORKERS COMP NUMBER
NYCIM 231398OtherWORKERS COMP NUMBER
NYCIM 231398OtherWORKERS COMP NUMBER
NY010142554OtherBLUE CHOICE